Kaiser Authorization

Forms

Forms may be printed out and either mailed or faxed back to our office so that we can begin working on your case immediately. If you have any questions at all about these forms, please feel free to contact our office and we will answer any concerns you have. We can be reached toll free at 800-699-9097.

Information about forms:

Retainer Agreement: With Kirbys Law, there are no upfront costs to you.

 

Consent To Release Records: This form allows us to obtain copies of your medical and employment records for your case.

 

Medicare Form: Required by Federal Government as to whether or not you have Medicare.

 

Personal Injury Questionnaire: This form allows us to obtain some background information about you. It is a bit long but it is very helpful for your case.

Kaiser Authorization: Allows us to get copies of Kaiser records.

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Steven Kirby - Licensed in California

Margaret Kirby - Licensed in California

James Kirby - Licensed in California and Nevada

© 2018 by Kirbys Law.